Healthcare Provider Details

I. General information

NPI: 1487858932
Provider Name (Legal Business Name): SIMI OBSTETRICS & GYNECOLOGY MEDICAL GROUP A MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 RED TAIL WAY
SIMI VALLEY CA
93065-7232
US

IV. Provider business mailing address

1147 RED TAIL WAY
SIMI VALLEY CA
93065-7232
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-8055
  • Fax: 805-520-8849
Mailing address:
  • Phone: 805-527-8055
  • Fax: 805-520-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CATHERINE KIM
Title or Position: CFO
Credential: MD
Phone: 805-527-8055